Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings

Abstract

Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56–61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget’s disease, ductal carcinoma in-situ and invasive carcinoma. MRI’s high negative predictive value of 87–98.2% is helpful in excluding malignant etiologies of PND.

Paget's disease of the nipple with underlying occult invasive carcinoma detected by magnetic resonance imaging and second-look ultrasound: Case report

“…More than 90 % of Paget's disease cases are associated with an underlying breast malignancy. Therefore, even when traditional mammography and ultrasound do not reveal abnormalities, additional imaging studies such as breast MRI should be considered for further evaluation, especially in patients with PDN [ 3 ]. Lim et al [ 8 ] underscored the significance of MRI in Paget's disease and reported its importance in assessing the nipple-areolar complex and detecting potential underlying breast malignancies.…”

“…This condition was first documented by a British surgeon, Sir James Paget, in 1874. PDN typically affects the skin around the nipple in women and is associated with an underlying breast carcinoma, accounting for approximately 1 %–3 % of breast malignancies [ [1] , [2] , [3] , [4] ]. Despite its relative rarity, PDN poses significant diagnostic and therapeutic challenges due to its clinical similarity to benign dermatological conditions and its frequent association with in situ or invasive carcinoma (observed in 90 %–100 % of cases) [ 1 , 2 , [5] , [6] , [7] , [8] , [9] ].…”

The Use of MRI to Detect Malignancy in a Patient Presenting With Unilateral Bloody Nipple Discharge

“…The detection of breast cancer is based on angiogenesis, and after one to two minutes of administration of gadolinium, there is prompt uptake and release due to the increased permeability of tumor blood vessels [4]. Studies show MRI has a 93-100% sensitivity for detecting invasive breast cancer but is not generally used unless suspicion for malignancy remains high after MMG and US are inconclusive [1][2][3][4]. Ductography is an invasive procedure that can cause discomfort and pain and can only be used when discharge is present as the duct that is draining is cannulated and filled with dye to allow for evaluation.…”

“…Nipple discharge presents in approximately 3-10% of women and is classified as either physiological or pathological. Physiologic discharge can be green, white, or yellow and presents bilaterally and non-spontaneously [ 1 ]. Benign papilloma is the most common etiology of pathologic nipple discharge [ 2 ].…”

“…Unilateral, spontaneous bloody nipple discharge (BND) presents due to an underlying malignancy in 5-21% of cases with ductal carcinoma in situ (DCIS) being the most common malignancy [ 2 ]. BND can be the initial presentation for papillary lesions, ductal ectasia, periductal mastitis, nipple adenoma, Paget’s disease, DCIS, and even invasive ductal or lobular carcinoma [ 1 ].…”